Tuesday, June 30, 2009

My secretary Mary saved this awesome message that came in over lunch hour.

Slurred voice: "I need to make an appointment to see Dr. Grumpy. I take lots of pain medications, because I'm in constant pain, sometimes. But I'm not taking any right now, because my pain is so bad that I can't take my medicines. I've run out now, but still have plenty, but think I might need more."

I told Mary that if they call back to tell them I don't take their insurance. Even if it's cash.

Monday, June 29, 2009

All right, this is an actual e-mail Mrs. Grumpy got from her Mom today about a new set of pots & pans my in-laws bought. I think it's weird, but maybe it's just me.

"Okay, we went to a Salad Master sales dinner and bought us some top-of-the-line cookware.

We didn't get the big set, which has enough pans to cook for an army. We bought a starter set and got 3 extra pieces just for foolishly buying this over-priced cookware. It is very nice, and I know I will like it.

It comes with a 'beyond your lifetime warranty', meaning it's guaranteed to outlast us. So we had to list you as a next of kin for who the set and warranty will transfer to when we die.

So your name is listed as an owner also...so when we no longer need, or can use the cookware...behold, you are the proud owner, and are already registered with the company as the future owner."

Sunday, June 28, 2009

To briefly touch on my only other professional encounter of this insane sort, in 1997 I was taking call for an Epilepsy Monitoring Unit. The night nurse was named Sue and, while a good nurse, she was unusual to say the least.

Anyway, one night I'd dozed off at home in bed, and was woken by Sue.

Dr. Grumpy: "This is Dr. Grumpy."

Sue: "This is Sue, in the EMU. She's dead."

Dr. Grumpy: "Oh my God! Who? Mrs. McFadden in room 3?"

Sue: "No. Princess Diana."

Dr. Grumpy (still a bit drowsy): "Is that the lady in room 4? I thought she went home yesterday."

Sue: "No, Princess Diana, ya know, the British royal family and all. She died in a car crash."

Friday, June 26, 2009

Okay, I just want my patients to know that there are some good excuses to cancel your appointments at the last minute. AND MICHAEL JACKSON'S DEATH IS NOT ONE OF THEM!!!

So far today I've had 1 person cancel because she's too depressed over his death to make her appointment today, another who said he can't come in because he's too busy watching continuous coverage on E! about it. And a third who (somewhat vaguely) canceled "because of the world situation".

Wednesday, June 24, 2009

WARNING: THE FOLLOWING POST IS NOT FOR THE SQUEAMISH. I MEAN, IT'S NOT AS BAD AS THIS STORY FROM MY ESTEEMED COLLEAGUE ERP, BUT IT AIN'T GOOD EITHER. SO STOP READING NOW IF YOU THINK IT'S GOING TO FREAK YOU OUT, OR IF YOU'RE EATING.

Before Viagra and it's cousins, there were some other methods of waking Sheriff Woody. They're still out there, for those who have issues with Viagra.

One of them is Caverject (or Alprostadil for my pharmacy fans). This is fairly effective at getting it up for special occasions. They have to be pretty special, though, because Caverject has to be injected directly into the side of your winkie for it to work. What fun.

Because it came to market before the era of direct-to-consumer celebrity advertising, we were fortunately spared TV ads featuring Eric Clapton singing (to the tune of "Cocaine"):

"If your lady is hotJust give yourself a shot-Caverject."

But I digress.

I have a patient who's been using Caverject for years. For whatever reason he can't use one of the newer drugs. He's kind of an aging, swinging, disco guy. In the 70's he was swinging, single, wearing gold chains, and picking up babes at the disco. In 2009 he's still swinging, still single, still wearing chains, and now picking up aging babes at the disco.

A few weeks ago he had a small stroke (he's fine now), and as a result he's now on Coumadin, a potent blood thinner. This gives new meaning to "Stayin' Alive".

So last Saturday he was out getting his boogie on and picked up Ms. Agingdiscoqueen. They went back to his place for some wild times. He shot himself up with Caverject and the fun began.

And abruptly ended. Apparently she got on top, and while she was riding the disco pony, blood began squirting out the side where he injected Caverject (thanks to Coumadin). Seeing blood flying all over those dark areas killed the mood fast. She ran out, and likely went home to douche with bleach.

He's been visiting me and his cardiologist today, to discuss stopping Coumadin.

I saw a guy this morning who was in ER over the weekend, and he brought in the generic preprinted instruction sheet they gave him. I glanced over it, and noticed this line:

"If you've been given suppositories for your condition, do not store them above room temperature or unwrap one before you are planning on using it. If you haven't been given suppositories for your condition, don't".

Monday, June 22, 2009

This morning the hot water heater for my office was on the blink. So I called maintenance to let them know.

The 12 year old answering the phone kept telling me someone would be over "in 5 minutes". So after 3 hours of nothing happening (except for my staff getting pissed off) I called again, only to reach the same 12 year old.

I asked her when a realistic idea of a repair would be:

Ms. Twelveyearold: "Look, I really don't know. Um, do you live near here?"

Dr. Grumpy: "Yes, why?"

Ms. Twelveyearold: "Then why don't you just go get some?"

Dr. Grumpy (not sure I've heard right): "Excuse me?"

Ms. Twelveyearold: "Why don't you go home and fill up some tupperware with hot water? Then you could store it in your office or fridge or wherever until you need it, while we try to get someone up there to fix it."

Saturday, June 20, 2009

I saw a lady on Friday for a tremor, and put her on a drug called Inderal for it. She gratefully called today to wake me from my Saturday afternoon nap.

Dr. Grumpy: "Hello, this is Dr. Grumpy."

Ms. Ruinedmynap: "Hi, I'm calling because I woke up this morning with a small bruise, about the size of a dime, on the left side of my forehead. Maybe I bumped my head on the night table during my sleep. Can Inderal cause a bruise like that?"

Dr. Grumpy: "No, it shouldn't".

Ms. Ruinedmynap: "Good. Because I haven't started taking it yet, but wanted to be sure before I do."

Friday, June 19, 2009

Okay, gang, today I am going to hit the email bag! One of you writes in:

"Hi Dr. Grumpy,

Hello! I am a staff pharmacist for an evil chain pharmacy, and had an interesting moment while working today. We received a fax for a prescription for a patient, but the date of birth didn't match our records. When we called the office to verify the prescription, the nurse said that the prescription wasn't supposed to be for that specific patient, and she didn't know who the prescription was for. I guess WE'RE supposed to figure out whose prescription this is? Anyway, I was wondering if this happens in your office.

Thanks!

PS."

Well, PS, I gotta say that we have our share of prescription confusion on this side of the trench, too. I'm not infallible, and am sure me and my staff have (unintentionally) given a pharmacist cause to apply Rogaine. On the other hand, we honestly do try our best to play nice with you guys. I mean, we need each other, right?

We do get a lot of patient voice messages like "Hi! I need my medications! Thank you.", with no useful information. Or "Dr. Grumpy wanted to know how many of the brownish-white pills I take, and it's three." And Annie's favorite "Hi, I saw Dr. Grumpy back in 2005, and he said there were pills that might help whatever my condition is, and I'm ready to take them now."

To answer your question, though: that physician's office appears to have staff from a planet where mind-reading skills are everyday norms, and expect no less from those who fill prescriptions. Many of my patients are from the same place. So, since it appears that you are as incompetent as I am at reading minds, I'd have to say we will both continue to get such odd calls.

The physician's office should have known better then to suggest you solve the problem with your mind-reading skills. Since they originated the script, somebody there should get off their butt and go ask the doctor what he REALLY meant, although he may not know, either. In fact, for all you know it was sent by a chimpanzee playing with his fax machine.

Tuesday, June 16, 2009

The following is a public service announcement from Grumpy Neurology, Inc.

While I always strongly recommend NOT having anything to do with those modern deathtraps called ATV's (I see way too many young people with brain and spinal card injuries from them) a new ATV danger has recently come to my attention.

When going water skiing at Lake Sewage with your buddies, ALWAYS remember to bring your water skis. Having them makes water skiing much more enjoyable, not to mention possible.

If you've forgotten your skis, and are too drunk to use common sense, IT IS NOT ADVISABLE TO TRY USING AN ATV IN PLACE OF THE SKIS!!!

Extensive studies of physics (Newton, Einstein, Hawking et al) have shown that the ATV will likely sink like a stone, or float upside down with it's wheels at the surface. Whether it has 3 wheels or 4, or how fast you drive the boat, are irrelevant. Revving the ATV's engine will not change this outcome, and it will shut down upon immersion, anyway.

Medical studies have also shown that having a blood alcohol content well beyond the legal limit WILL NOT lessen the chance of this being an unsuccessful attempt at discovering a new watersport.

Trying to argue with the neurologist who was called to see you for your head injury will NOT alter the laws of physics and buoyancy. While I can understand why the consumption of alcohol might have led you to believe that the ATV would run fine on water (hey, it did great on snow last winter! And that's water!) it most assuredly will not.

Monday, June 15, 2009

I went to my local pharmacy today for my Sarcasma refill (without it I'd have no patients, or friends, or staff).

Local Pharmacy was hopping. Very busy. Long line, only one poor pharmacist with dark circles under his eyes was working. Looked badly understaffed and overworked (I later found out they had 1 pharmacist and 2 techs call in sick today). And the pharmacist was frantically trying to keep from tearing his remaining hair out.

Finally there was only one elderly lady ahead of me, and I patiently waited my turn. Suddenly the cashier turned around and yelled "I need the pharmacist to counsel over here!" The bleary-eyed pharmacist actually was holding a phone receiver to each ear when this happened.

He paused for maybe 5 seconds, put one of the phones on hold, glanced at the computer screen next to him, and then yelled across the room: "Verapamil, uh, might make you constipated, or make you lightheaded!"

Sunday, June 14, 2009

So on Saturday night Mrs. Grumpy and I actually found a (drumroll please) babysitter! Date Night! Woohoo!

So we went over to La Enchilada Grande. There was a large van in the parking lot, but I didn't pay much attention to it.

When we got inside the place was almost full. There was a large group at a big table in the center. We got a booth and began perusing menus and munching chips.

To my horror, I belatedly realized that the large group was a dinner field trip from La Casa deMentia, a local Alzheimer's home. And many of them were my patients.

Gotta love these people. They can't remember how to tie shoes, count money, or who their family members are, BUT THEY SURE AS SHIT CAN SPOT AND RECOGNIZE THEIR FREAKING NEUROLOGIST FROM ACROSS THE ROOM IN A BUSY RESTAURANT!!!

As a result our dinner was frequently interrupted by varying patients wandering over to say hi, help themselves to our chips, and/or ask directions to the bathroom. And since they have Alzheimer's disease they didn't recall doing so. One lady (with mismatched shoes and her blouse on inside-out) came over 3 times in one hour to tell me I looked familiar and to ask if we'd met before. One of them announced to her table (and the restaurant) that I was either her doctor or her grandson. Another asked me if I had any samples of "those memory pills, I forget what they're called".

We went elsewhere for dessert. Mrs. Grumpy noted the van's license plate for future reference if we see it in a parking lot again.

Saturday, June 13, 2009

So I got called to come in to the hospital this Saturday morning. 21 year old woman who woke up this morning, completely paralyzed from the waist down. While driving in I turned over the possibilities: spinal card tumor, multiple sclerosis, big herniated disk, etc.

So I saw the patient, and as advertised she couldn't move either leg. There were some things about her story that didn't add up, but certainly she needed further work-up.

While I was out at the nurses station dictating a note she walked out of her room to ask where the smoking patio was.

As soon as she saw I was still there she ran back in and laid down on the bed.

Thursday, June 11, 2009

I ordered some med samples (Axert) because Ortho-McNeil finally canned my incompetent drug rep. They came with a cover letter saying "Dear Dr. Grumpy, thank you for taking the time to order Axert samples, yadda yadda yadda."

Attached to the letter was an invoice of what was in the box.

Notice the circled item on the invoice: "Personalized Thank You Letter"

I was called in during the night to see a sweet old lady who'd fallen down and had a small brain bleed. When I was done examining her she asked me if I'd talk to her son "Big Hank" out in the waiting room. I said I'd be happy to.

Wednesday, June 10, 2009

I stopped on the way home for some tomatoes, and was in line at the checkout. The guy in front of me was a 30-something guy buying a crapload of vitamins and supplements.

Clerk: "You sure take a lot of vitamins."

Mr. Vitaminjunkie: "Yeah, cause, like, all the food today has, like, lot of unnatural stuff in it. So I take all these vitamins and only eat, like, natural and organics and stuff. That way I know I am going to stay healthy, and am like, not putting anything dangerous in my body."

Tuesday, June 9, 2009

Dr. Dickweed is an internist upstairs from me. He's been there since I moved into the building over 10 years ago.

He's never referred to me. I'm polite, I've tried to talk to him in the elevator. When I started out 10 years ago I went by his office asking for referrals. He's coldly informed me that he doesn't trust, or refer to, physicians under 60 years old. Whatever. He's entitled to his opinion.

Anyway, my secretary interrupted me today to say that Dr. Dickweed was on the phone for me. This was a first, and I picked up the phone.

Dr. Grumpy: "This is Dr. Grumpy."

Dr. Dickweed: "Grumpy, this is Dickweed. I just want you to know that I'm out of Topamax samples, and one of my patients needs some. So I told her to come by your office to get some. Your staff doesn't need to schedule her for an appointment, and you don't need to see her. Just give her whatever Topamax samples you have."

Dr. Grumpy (somewhat taken aback by this kind request): "Dickweed, I'm out of Topamax samples."

A new drug rep, Ms. Pharmafakeones, brought lunch to my office today, piling a bunch of sandwiches wrapped in white paper on the break room table.

Ms. Pharmafakeones was furious. She'd ordered 4 roast beef and 4 turkey sandwiches, and was angry because she'd asked the deli to label them so people could tell what kind of sandwich it was without opening it.

Instead (according to her), the deli had only written "their own codes" on the wrappers, so she wasn't sure which were which.

My staff noticed that 4 of the wrappers said "RB", and the other 4 said "Gobbler".

Ms. Pharmafakeones was amazed at how my staff were able to figure this out.

Monday, June 8, 2009

Last night, on my way home from the hospital, Mrs. Grumpy called and asked me to stop for some tomatoes (don't get me started). So I pulled into Local Grocery.

Inside Local Grocery, one aisle looked like a war zone. A large cardboard display had fallen over and was torn in half. Cans were everywhere, like a bulldozer had driven through a display. There were a few potted plants from a nearby gardening display that were lying on their sides, with soil spilling out. A small army of teenagers with push brooms were working on the mess.

But, since I was in hurry, I grabbed my tomatoes and left.

I'd forgotten about it until today. My 10:30 is a sweet old lady with serious balance problems, who recently got a motorized scooter. So I asked her how she's been doing with learning to drive it.

"I've been doing fine. Or at least I thought I was. I keep forgetting how to stop it, and last night I was going down the aisle at Local Grocery, when I tried to slow down and swerve around this huge display of cans........"

Being a neurologist means sometimes being LOUD. In residency, no matter how quiet and soft-spoken you may be, you learn how to SHOUT, yet still be polite.

Is this because we deal with little old deaf people? A little. But the main reason is because we are frequently consulted to wake the dead (or at least try) and evaluate the comatose. In order to do so you need to make sure that this person definitely isn't responding. So you learn to be able to shout into their ears in the gigadecibel range, to see if they can actually hear you.

And you yell simple commands, trying to break through a wall of brain damage, drugs, and loud ICU machines to see if there's anyone in there. "MR. JONES! CAN YOU WIGGLE YOUR TOES FOR ME?" or "MRS. SMITH! CAN YOU SHOW ME TWO FINGERS?"

If you don't believe me, just ask any ICU nurse. They often carry their own earplugs for when they see a neurologist going into a patient's room.

So this morning I got called in to evaluate a guy with brain damage named Mr. Dick.

So I did my usual shouting routine to try to wake him.

"MR. DICK! CAN YOU HEAR ME? CAN YOU HOLD UP TWO FINGERS?"

No response.

"MR. TOES! CAN YOU WIGGLE YOUR DICK FOR ME?"

Mercifully, the patient didn't respond. The nurses' station, however, broke down in hysterical laughing. So did the patient 2 doors down. I'm sure I turned bright red when I realized what I'd said.

The real estate market here, like everywhere else, has tanked. It's damn near impossible to sell a house, which makes it even harder to buy another one if that's what you're trying to do.

So several local realty companies have been using the gimmick that if you buy a house from them, and can't sell your old one, they'll buy it from you.

This afternoon, on my way to a meeting, I passed a house that was obviously abandoned. Some windows broken, a front door hanging loose, graffiti, etc. It was obviously being used as a crackhouse, or homeless shelter, or teenage drinking hangout, or all of the above.

And in front of this wreck was a big sign from a realtor: "If you buy this house, I'll take your old one off your hands!"

Thursday, June 4, 2009

Nothing seems to bring out the whackies and WTF's quite like a full moon. This isn't just my opinion, it's a fact. You can track it by ER data, police calls, etc. No one knows why. My guess is that it activates some primitive unidentified hormone, or cell group, or something, in our brains. Maybe related to the things that cause other animals to spawn, or howl, or whatever, when the full moon is out.

But I digress.

This afternoon an irate elderly lady called. My secretary is out, so my nurse and I are fielding the calls ourselves.

She chewed me out. "Dr Grumpy, my husband, Mr. Backpain, has been in the hospital for 2 days waiting to see you. Dr. Brilliantinternist is his regular doctor. Anyway, they're ready to discharge him home, but are still waiting for you to come say it's okay".

I told her I'd look into this. I hadn't received any hospital consults on this guy. Neither had my nurse. I even called my secretary at home. Nope, not her either. I listened to all 4 of the office's voicemail boxes to to see if something had been forgotten. Nope. Zip. Nada.

So I called Dr. Brilliantinternist to get to the bottom of it. I pride myself on seeing patients when called to do so, and it ticked me off that someone might think I was slacking off.

Dr. Grumpy: "Hey, Dr. Brilliantinternist, it's Ibee Grumpy"

Dr. Brilliantinternist: "Hi, Ibee. What's up?"

Dr. Grumpy: "A lady is calling saying I was supposed to see her husband, Mr. Backpain, at the hospital?"

Long pause.

Dr. Brilliantinternist: "He's not in the hospital. I just saw him here an hour ago."

Dr. Grumpy: "WHAT?!!! Why the hell is his wife calling me then?"

Dr. Brilliantinternist: "No idea. Sounds like SHE needs to see you, though. I'll have my secretary set it up".

The following message was left on my office voice mail over lunch hour today.

"Yes, hello. I need either Dr. Grumpy or his nurse to call me back. When I left my house to go shopping my jigsaw puzzle wasn't completed. When I got home, however someone had finished it. So I need to know how to proceed. Thank you".

Wednesday, June 3, 2009

So I tossed stinky Cooper in the tub, and while I was fighting to rinse him off, stinkier Snowball wandered in to see what I was doing to his partner. My son Frank came in behind Snowball.

As soon as Snowball realized a bath was coming (which can take a bit, he's kinda slow) he started growling and backed out of the room. I told Frank to grab Snowball's collar, and to NOT let go of it under penalty of death. So he held on tight, while Snowball twisted and fought and tried to get away.

I turned back to the tub, dried off Cooper, and then turned around to grab Snowball.

My 3:00 called 5 times for directions to my office, and kept arguing with my staff that WE had the wrong cross streets (I've been here since 1998, for crying out loud).

She shows up 10 minutes late, stomps up to the front desk, shoves a portable GPS system in my secretary's face (hasn't even signed in or introduced herself) and yells "THERE! WHAT DO YOU THINK OF THAT!"

My secretary can see nothing wrong with what's on the screen, and says so. So the woman starts arguing that our building isn't where it's supposed to be according to GPS.

She then claimed that obviously the building had been moved since the GPS system was set-up! I swear!

Lady, this is a multistory, 15 year old, brick and concrete medical office building. I promise you that, short of major tectonic activity, they don't move.

Okay, fans, I had a neurology consult (granted, I don't get many other kinds) at the hospital this morning, on a 16 year old guy who began acting weird around 1:00 a.m. last night.

The following is, I swear, what the admitting hospitalist's note said:

"Impression: Patient who took LSD around midnight, and is now brought in for bizarre behavior and hallucinations. We will consult neurology to determine cause of altered mentation, check MRI, EEG, and labs. May need spinal tap to rule-out meningitis."

Tuesday, June 2, 2009

Like every other doctor's office, I have a sign-in sheet up front. At the top it says my name (Ibee Grumpy, M.D., Neurology), today's date, and asks people to write their names and the time of arrival.

So some lady showed up this morning, wrote her name on it (Ima Bimbo) and the time.

THEN she actually wrote next to that "I am not here to see Dr. Grumpy!!! I am here to see Dr. Harry Mole, a dermatologist in suite #405, but this is the only sign-in sheet I could find!"

Excuse me, Ms. Bimbo, but if I walked through an office door that said "Ibee Grumpy, M.D., Neurology, Suite #600" AND saw the same thing on a sign-in sheet, I (and likely the vast majority of the mammal population) might consider that maybe I was the one in the wrong office.

In fact it would never occur to me (or any of my office staff in a just-held unscientific poll) to write on the sign-in sheet that I was here to see another doc (in another suite, no less!) then have a seat in the lobby!

There's nothing wrong with asking us for directions to Dr. Mole's office.

But signing in and writing that you're here to see a doc who obviously ain't here???????.

My cell phone rings at 11:58 p.m. on a Sunday. It's the hospital on the ID.

Dr. Grumpy: "This is Dr. Grumpy."

Miss Idiotclerk: "Hello? Is this Dr. Grumpy?"

Dr. Grumpy: "Yes."

Miss Idiotclerk: "You were here this afternoon and wrote an order for a head CT scan on Mrs. Stroke."

Dr. Grumpy: "Yes?"

Miss Idiotclerk: "So did you want that scan on her head?"

For those of you who are wondering, all I said was yes. Lord knows I'd LOVE to be sarcastic with this imbecile, especially when she's just woken me up for such an insanely stupid question. But, as I've learned from experience, doing so will get me written up to the hospital's board, and then I'll have to appear at some meeting to apologize for my actions, and write this bozo an apology, and agree on a 12 step plan to manage my anger. At the same time, though, there is nobody at the hospital for ME to complain to about criminally stupid employees.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

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Dr. Grumpy is for hire! Need an article written (humorous, medical, or otherwise) or want to commission a genuine Grumpy piece for your newspaper/magazine/toilet paper roll? Contact me to discuss subjects. You can reach me at the email address below, or through my Linked-In profile.

Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.